Endoscopic capsular suture plication instrument and method

ABSTRACT

An instrument for surgical suturing includes a shaft, and a needle disposed slidably for longitudinal travel with respect to the shaft. A prong formed on one end of the shaft projects across a longitudinal axis of the needle and has an opening formed through the prong that provides a clearance through which a tip portion of the needle passes when it is advanced. Slots formed on a surface of the prong facing the shaft releasably hold suture across the opening. The suture is held in the slots by passing the suture strands separately back around the sides of the prong, then together up through a channel formed on the prong above the slots, and securing the strands in a pinch slot formed in a handle of the instrument. Advancing the needle through the clearance allows a hook formed on the tip of the needle to capture the suture. Once withdrawn, the needle draws the suture back through tissue pierced during advancement. The suture is released from the slots and drawn back through the tissue for further knot tying and suturing to effect the tissue repairs.

[0001] This application claims the benefit of U.S. ProvisionalApplication No. 60/330,490, filed Oct. 23, 2001, and U.S. ProvisionalApplication No. 60/350,034, filed Jan. 23, 2002.

BACKGROUND OF THE INVENTION

[0002] 1. Field of the Invention

[0003] The invention relates to endoscopic suturing, and moreparticularly to instruments for arthroscopic repair of torn tissue, suchas glenoid repair and capsular suture plication.

[0004] 2. Description of the Related Art

[0005] Intracorporeal suturing, particularly suturing tissue duringarthroscopic surgery, presents challenges to a surgeon who mustmanipulate suturing instruments in confined spaces and through arelatively small incision. One device which has been developed forfacilitating suturing during arthroscopic surgery is disclosed in U.S.Pat. No. 4,890,615. This instrument has a cannulated or hollow needlesecured to a jaw positioned near the end of a long tube. The jaw can bemanipulated by a hand grip to press the needle through the tissue to besutured. Suture material is then fed through the tube from a spoolattached to the hand grip into the hollow needle and therefore throughthe tissue. Enough suture material is advanced through the needle sothat when the needle is withdrawn from the tissue and the instrument isremoved from the incision, a portion of the suture material remainswithin the tissue. The suture material is then tied in a mannerwell-known in the art so as to secure the suture material to the tissue.

[0006] While the suture punch of U.S. Pat. No. 4,890,615 generally iseffective in suturing tissue, there are several disadvantages associatedwith using this instrument. For example, the instrument requiresmanually advancing the suture material through the needle bymanipulating the spool, which is often somewhat difficult to do duringsurgery. In addition, the surgeon must verify that enough suturematerial has been advanced through the needle so that when theinstrument is withdrawn from the incision, the suture material is notinadvertently pulled through the tissue. Furthermore, because the suturematerial must be fed up and through a hollow needle, tissue or otherdebris present in the surgical site may block the opening in the needle,making it difficult to pass the suture material through the needle. Inaddition, because rotating the spool against the braided suture materialtended to cause the braided suture material to expand such that it wasunable to pass through the tube, only monofilament suture material cangenerally be used. This is disadvantageous because braided suturematerial is generally stronger than monofilament suture material.Finally, this particular instrument cannot generally be used tosimultaneously pass several segments of suture material through thetissue, which is required for certain types of sutures such as amattress suture.

[0007] The Caspari suture punch, disclosed in U.S. Pat. No. 5,522,820,was developed to provide a suturing instrument for arthroscopic surgerywithout the above-noted disadvantages. The Caspari suture punch is ahand instrument with a pivotable jaw and a stationary jaw. Thestationary jaw is provided with a needle that extends upwardly and has ahook on the proximal side. With the jaws closed, suture is threadedthrough an aperture in the movable jaw, such that the suture is disposedon the distal side of the needle of the lower jaw and is not engaged bythe hook. The instrument is inserted through a relatively small incisionin the patient with the jaws closed. With the jaws positioned adjacentthe tissue to be sutured, the surgeon opens the jaws (by manipulatingthe finger grip of the instrument disposed outside the patient), andthen closes the jaws to engage the tissue to be sutured. As this occurs,the needle penetrates the tissue to be sutured, and the suture iscaptured in the hook of the needle. When the movable jaw is then opened,the suture, which is captured in the hook, is drawn through the tissue.The instrument is then removed from the incision and the suture issecured around the tissue with a knot.

[0008] While the Caspari punch avoids some of the disadvantages of theprior spool-fed suture punch, it is directed to applications in whichthe tissue to be sutured must be grasped, and thus requires a movablejaw mechanism. It would be desirable to provide an instrument forsuturing which does not require a movable jaw mechanism and is suitablefor applications such as rotator cuff repair or surgical plication of acapsule, i.e., capsulorrhaphy.

SUMMARY OF THE INVENTION

[0009] The present invention provides an instruments and method forsuturing tissue arthroscopically, in particular for rotator cuff repairor surgical plication of a capsule. The method utilizes a handinstrument to pass suture through soft tissue, such as a shouldercapsule undergoing plication.

[0010] The instrument features a needle slidably disposed in a tubularshaft. The needle is advanced to pierce through the tissue to berepaired. With continued advancement, a hook disposed at the end of theneedle engages a length of suture supported ahead of the advancingneedle on a prong that extends from the end of the instrument shaft. Theneedle then is withdrawn, drawing a captured loop of the suture backthrough the pierced tissue. The suture loop is available for subsequentsuturing or knot tying.

[0011] More specifically, tissue suturing begins by presenting theinstrument, loaded with suture, through an arthroscopic cannula, forexample. The operative end of the instrument is positioned, with theneedle withdrawn, proximate the tissue to be repaired. The needle thenis advanced to pierce the tissue. Further advancement of the needlebrings it clear of the pierced tissue to approach a length of suturesupported in a slot on the extended prong on the end of the instrument.A hook formed toward the tip of the needle captures the suture. Drawingthe needle back pulls a loop of the captured suture through the tissue.

[0012] Operation of the instrument is facilitated by additional featuresof the invention. One handed manipulation of the instrument, forexample, is simplified by the provision of a thumb slide. Accordingly,the instrument can be operated using the thumb of one hand to advancethe shaft through the tube to pierce tissue, capture the suture, andwithdraw the captured suture back through the tissue. The needle may bespring loaded to assist retraction. In addition, the needle shaft can beconfigured to be withdrawn completely from the instrument to facilitatesuture manipulation and withdrawal of the instrument from the patient.Further, the instrument can be made to be disposable, and can bemanufactured with a malleable shaft which can be bent into variousconfigurations to facilitate access to tissue.

[0013] Other features and advantages of the present invention willbecome apparent from the following description of the invention whichrefers to the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

[0014]FIG. 1 is a perspective view of a tissue suturing instrumentaccording to a preferred embodiment of the present invention.

[0015]FIG. 2 is a perspective detail view of the tip of the tissuesuturing instrument of FIG. 1.

[0016]FIG. 3 is a perspective view of the instrument of FIG. 1, shownwith the needle in an advanced position.

[0017]FIG. 4 is an enlarged view of the tip of the instrument as shownin FIG. 3.

[0018]FIG. 5 is a perspective view of the instrument of FIG. 1 shownloaded with a length of braided suture.

[0019]FIG. 6 is an enlarged view of the tip of the instrument as shownin FIG. 5.

[0020]FIG. 7 illustrates a step of performing surgical suture plicationaccording to the present invention.

[0021]FIG. 8 illustrates a further step of performing surgical sutureplication according to the present invention.

[0022]FIG. 9 illustrates an additional step of performing surgicalsuture plication according to the present invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

[0023] Referring to FIGS. 1-9, a suturing instrument 2 according to apreferred embodiment of the present invention is shown. The instrumentincludes a handle 4 supporting a cannulated shaft 6. The cannulatedshaft 6 terminates in a stationary, prong-shaped tip 8. Optionally, atleast a portion of shaft 6 can be bendable, formed of a malleablematerial, for example, to facilitate directional control of sutureplacement. A needle 10 extends through shaft 6 and is operated by thumbslide 12. Needle 10 is shown in a retracted position in FIG. 1.Instrument 2 includes a finger support 14 for ease of handling, and asuture pinch slot 16 for capturing tensioned suture, as described belowin connection with a preferred surgical procedure using the instrument.

[0024] Prong-shaped tip 8 is illustrated in greater detail in FIG. 2.Tip 8 ends in a point 18. Above point 18, tip 8 is configured to definean opening 20 in axial alignment with needle 10. A pair of slots 22formed in tip 8 on either side of opening 20 are used to capture asection of a suture loop guided through channel 24 formed on the top oftip 8, as described further below.

[0025] Referring to FIGS. 3 and 4, instrument 2 is shown with needle 10in a partially advanced position to reveal hook 26 formed at the end ofneedle 10. Hook 26 is shaped to capture suture held in slots 22 acrossopening 20 when needle 10 is advanced into opening 20, as describedfurther below in connection with a preferred method of surgical suturingaccording to the present invention.

[0026] Referring to FIGS. 5 and 6, instrument 2 is shown loaded with alength of braided suture 30 in preparation for performing surgicalsuturing. Suture 30 is looped through slots 22 across opening 20. Theslots 22 face proximally toward needle 10. Two legs of the suture loopare passed separately around the outside of the prong, upwardly anddistally, and then together proximally through channel 24 on top ofprong 8. Suture 30 is passed along one side of instrument 2 and securedunder tension in suture pinch slot 16.

[0027] Referring to FIG. 7, a step is illustrated in a preferredprocedure for performing surgical plication of a capsule 32. Thecapsulorrhaphy secures folded pleats of tissue in an effort to reducelaxity in the capsular tissue. Instrument 2 is loaded with suture 30 asdescribed above, and is inserted inferiorly along the capsule. Needle 10of instrument 2 is maintained in a withdrawn position by manipulation ofthumb slide 12, optionally by the urging of a spring loaded inside thehandle.

[0028] Prong 8 of instrument 2 is shown surrounding a tuck or fold 34 ofcapsular tissue. The fold is formed by engaging the capsular tissue withpointed end 18 of instrument tip 8 and drawing the instrument back inthe direction of arrow A in FIG. 7. The retrograde motion folds asignificant amount of tissue into the prong.

[0029] Referring to FIG. 8, the preferred capsular plication methodproceeds with advancement of needle 10 through the tissue of fold 34.Needle 10 is advanced by the surgeon manipulating thumb slide 12 in thedirection of arrow B of FIG. 9. As the end of needle 10 advances throughtissue fold 34 and into opening 20, needle 10 engages the portion ofsuture 30 held across opening 20 between slots 22. Further advancementof needle 10 causes the portion of suture 30 to become captured by hook26 (FIG. 4).

[0030] Referring to FIG. 9, instrument 2 is shown having been withdrawnfrom capsule 32, leaving suture 30 threaded through capsular tissue inpreparation for suture knot tying to secure tightening fold 34. Prior towithdrawing the instrument 2, suture 30 is released from pinch slot 16,and needle 10 is withdrawn from the tissue fold by moving thumb slide 12back. Suture 30 is then released from hook 56, and tied off to tightenthe capsule, or one suture end can be inserted through the eyelet of asuture anchor prior to insertion as a combined capsular plication andBankart repair.

[0031] Although the present invention has been described in connectionwith capsular plication, the instrument also is useful for othersurgical procedures, such as labral and rotator cuff repairs.

[0032] While preferred embodiments of the invention has been describedand illustrated above, it should be understood that these are exemplaryof the invention and are not to be considered as limiting. Additions,deletions, substitutions, and other modifications can be made withoutdeparting from the spirit or scope of the present invention.Accordingly, the invention is not to be considered as limited by theforegoing description but is only limited by the scope of the appendedclaims.

What is claimed as new and desired to be protected by Letters Patent ofthe United States is:
 1. An instrument for surgical suturing,comprising: a shaft; a needle disposed slidably for longitudinal travelwith respect to the shaft; a prong on one end of the shaft, the prongprojecting across a longitudinal axis of the needle and having anopening formed through the prong that provides a clearance through whicha tip portion of the needle passes when it is advanced; and slots formedon a side of the prong facing the end of the shaft and supporting alength of suture across the opening formed through the prong, and achannel formed on the prong, the suture being held in the slots bypassing strands of the suture separately around sides of the prong andtogether through the channel formed on the prong.
 2. The instrument ofclaim 1, further comprising a handle, wherein the shaft is fixednonslidably to the handle.
 3. The instrument of claim 1, furthercomprising suture supported in the slots across the opening formedthrough the prong.
 4. The instrument of claim 1, further comprising asuture channel formed on the prong for holding the length of suture. 5.A hand instrument for soft tissue suturing, the hand instrumentcomprising: a tubular shaft having proximal and distal ends; a needledisposed slidably within the tubular shaft; and a prong formed on thedistal end of the tubular shaft for holding a length of suture in asliding path of the needle such that a hook formed on the needlecaptures the length of suture and, upon proximal movement of the needle,the suture is released from the prong, the suture being held in theslots by passing strands of the suture separately around sides of theprong and together through a channel formed on the prong.
 6. The handinstrument of claim 5, wherein the suture is released from a proximalface of the prong.
 7. A method for suturing soft tissue tears using ahand instrument having a tubular shaft, a needle slidably disposed inthe tubular shaft and having a hook formed on the distal end, and aprong formed on a distal end of the tubular shaft holding a length ofsuture, the method comprising the steps of: advancing the needle;engaging the length of suture with the hook in the needle; and slidingthe needle proximally such that the length of suture engaged by the hookis released from a proximal face of the prong and drawn back away fromthe prong.
 8. The method of claim 7, further comprising the steps ofproximating a tissue tear with the hand instrument.
 9. The method ofclaim 8, wherein the step of advancing the needle includes advancing theneedle through tissue.
 10. The method of claim 9, wherein the step ofsliding the needle proximally comprises drawing a loop of the length ofsuture engaged by the hook through the tissue.
 11. The method of claim8, wherein the tissue tear is a tear of the meniscus.
 12. The method ofclaim 7, further comprising holding the suture in the slots by passingthe suture strands separately back around sides of the prong, thentogether up through the channel formed on the prong above the slots. 13.The method of claim 12, further comprising the step of securing thestrands in a pinch slot formed in a handle of the instrument.